VBS 2023 Registration

Child Name (Required)

Gender (Required)

Age (Required)

Date of Birth (Required)

T-Shirt Size (Required)

Last Grade Completed (Required)

Name of Parent(s) (Required)

Home Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Home Church

Food Allergies (Required)

If yes to allergies, list them (Required)

Medican Concerns (Required)

If yes to medical concerns, please explain (Required)

Medical Insurance Carrier/ID#

Physician's Name

Physician's Phone Number

In case of emergency, contact (Required)

Home Phone / Cell (Required)

Relationship to Child (Required)

VBS Volunteer Name

T-Shirt Size

Volunteer Address

City (Required)

State (Required)

Zip Code

I UNDERSTAND THAT THE NAME OF CHILD ABOVE MAY BE IN PICTURES OR VIDEOS TAKEN DURING THIS VBS AND POSTED ON MEDIA PLATFORMS. ALSO, I UNDERSTAND THAT REASONABLE PRECAUTIONS WILL BE TAKEN TO SAFEGUARD THE HEALTH AND WELLBEING OF THE PARTICIPANTS IN THIS VBS AND THAT I WILL BE NOTIFIED AS SOON AS POSSIBLE IN THE EVENT OF AN EMERGENCY. IN THE CASE OF SICKNESS OR AN ACCIDENT, I AUTHORIZE AND CONSENT THE VBS TEAM, OR OTHER ASSOCIATED VOLUNTEERS OF THE VBS PROGRAM TO OBTAIN MEDICAL CARE FROM LICENSED PHYSICIAN, HOSPITAL, OR MEDICAL CLINIC FOR MY SON/DAUGHTER IN THE EVENT THAT MYSELF OR OTHER LEGAL GUARDIAN(S) CANNOT BE REACHED. I HEREBY DO RELEASE AND FOREVER DISCHARGE VISIONS OF HOPE MINISTRIES FROM ALL MANNERS OF ACTION, CLAIMS(MEDICAL OR OTHERWISE), WHICH THE CHILD I NAMED ABOVE SHALL OR MAY HAVE FOR ANY REASON, ARISING DURING MY CHILD'S ATTENDEANCE OF THE VBS.

Parent Signature (Required)

Date (Required)